[Hiring] Director of Prior Authorization Services @MedOne, L.C

Role Description

We’re hiring: Director of Prior Authorization Services. Every prior authorization is a moment that matters. Behind each one is a member waiting on a medication and a provider trying to get them the right care without the runaround. We’re looking for a Director to lead that work for our PBM.

• Own the strategy and operations for prior authorization, coverage determinations, and appeals across all lines of business.
• Lead a team of pharmacists, technicians, and intake staff.
• Drive faster turnaround times and a better experience for members and providers.
• Partner with Clinical, Formulary, Compliance, and Client Services leaders.

Qualifications

• PharmD or pharmacist license.
• 5+ years in PBM, managed care, or health plan operations.
• 2+ years leading managers and large teams.
• Working knowledge of Utilization Management Programs, commercial coverage determination and appeals requirements.

Requirements

• Minimum of a Bachelor’s Degree in Pharmacy or PharmD with current unrestricted licensure as a pharmacist.
• At least 2 years’ experience in a client facing or consultative role within the managed care or PBM setting.
• Must be a strong communicator with the ability to translate clinical information into a manner appropriate for both clinical and non-clinical audiences.
• High degree of emphasis on problem-solving skills, including identifying and accepting a challenging situation and creating and implementing a solution.
• Strong organizational, verbal and written communication skills with emphasis on attention to detail.
• Proficient in drug literature and clinical trial evaluation.
• Ability to work with a team.
• Strong working knowledge of Microsoft Office products including Teams, Word, PowerPoint and Excel.
• Knowledge of the PBM industry, formulary management, pharmacy claims and managed care principles and practices.
• Residency experience is highly preferred.

Benefits

• Competitive salary and bonuses that reward your performance.
• Comprehensive health, dental, and vision insurance.
• 401(k) with company match to secure your future.
• Generous paid time off and holidays.
• Opportunities for professional growth and development.
• A vibrant and collaborative work culture.

Company Description

MedOne is a full-service pharmacy benefit manager (PBM), serving clients and members nationwide. With a fully transparent, pass-through model, MedOne helps people conveniently access the most appropriate prescriptions at the most affordable price.